Case studies
Case Study 3 – Bulimia Nervosa
This 25 year-old female was raised as a vegetarian was admitted to the Mandometer® Clinic in San Diego. She had a 10-year history of severe bulimia nervosa according to the DSM-IV criteria. She had previously been treated in 7 eating disorder clinics and had been hospitalized 2 times for cardiac problems that were related to her disorder.
At assessment
Much of her life revolved around binge eating and vomiting 10-15 times daily and compulsively exercising 3 hours per day. She worked part time as a day-care aid. She spent $150-200 per day on food and regularly stole money from her mother and eventually accumulated a large credit card debt to pay for food. She described her life as chaotic “I would be driving and I would order food at a drive-through and eat in the parking lot, drive away and purge in a plastic bag wrapped around my stick shift.” She had frequent mood swings and her psychiatric status was clearly abnormal (obsessional acts and thoughts 19, anxiety 16.5, depression 14.5, with 6 as normal). She admitted suicidal thoughts but had mot attempted suicide. She was taking 60 mg Prozac daily and she complained of severe headaches.
Her BMI was 18.7 kg/m2 and she had abnormal glucose 60 mg/dL, urea nitrogen (BUN) 6 mg/dL, amylase level 134 units/L, folate 24.0 ng/mL, PH 9.0, bicarbonate 33 mEq/L.
She was living in an apartment with a female roommate, but she isolated herself from friends and family. She had to leave the apartment after half a year because she did not pay her bills. She went to her mother’s house when her mother was at work to binge eat and purge. The patient was verbally abusive toward the mother, preventing the mother from caring for her. The mother had given up on a positive outcome for her daughter, as she had so many treatment failures. Her father and brother refused to acknowledge that she had an eating disorder, regarding bulimia as a mental disorder that they regarded with shame. The mother accommodated the patient’s eating behavior by changing her own eating behavior to suit the patient’s needs. The food choices she made and the portion sizes she chose were precisely aligned with the patient´s rigid eating system. No guests would visit nor were invited to the house, since the patient vomited in plants, clogged the toilets with her vomit, and hid plastic bags filled with vomit around the house. This behavior pattern made the mother terrified for her daughter’s life and the mother cried regularly in despair.
Treatment.
She started the Mandometer® treatment program six days a week from 8:00 am to 7:00 pm for two months. All psychoactive drugs were withdrawn over the first three months of treatment. She normalized her eating behavior in three months with the use of Mandometer® training and a highly structured treatment program. After 30 days, the binge-eating, purging and excessive exercise was eliminated. After six months of treatment, her psychiatric symptoms were normal (obsessional acts and thoughts 5.5, anxiety 4.5, and depression 5.5, with 6 as normal). Her BMI = 20.1 kg/m2 and all blood tests were normal. She gradually started to socialize; she met a boyfriend and went back to college to complete her masters program. She recently gave birth to a healthy baby.
She had fulfilled our remission criteria, with a normal BMI, normal physiological status and normal psychiatric status, she was back to school and was neither binge-eating or purging. She will be followed for five years.